Atopic dermatitis

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, and the increase in cases and its occurrence presents a major problem for global public health. The distinguishing characteristics of AD are pruritus (itching) and a chronic course or series of chronic relapses during the course of the disease.

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. The distinguishing characteristics of AD are pruritus (itching) and a chronic state or series of chronic relapses during the course of the disease, usually beginning in childhood (early onset) but occasionally the disease can develop in adults (late onset). ).
Atopic dermatitis is the paradigm of genetic allergic diseases, and is often accompanied by other atopic diseases such as allergic rhinoconjunctivitis or asthma. These diseases can appear simultaneously or they can develop successively. Atopic dermatitis has a predilection for infants and young children, whereas asthma attacks prevail in older children and allergies to pollen in adolescents.
Considering that the progression of atopic disease begins with the appearance of AD, the treatment of the disease should not only focus on controlling acute episodes, but also that treatment should be aimed at improving the underlying genetic dysfunction of the epidermal barrier and the prevention of active dermatitis (maintenance therapies).
In the case of atopic dermatitis, since it is a complex disease, cooperation between dermatology, allergology and immunology specialties is suggested.

Atopic Dermatitis
Atopic Dermatitis

Atopic Dermatitis Epidemiology.

The current prevalence of atopic dermatitis in most high-income countries and some low-income countries is approximately 10 to 30% in children and 2 to 10% in adults, increasing by two or three times the number of cases in the last three decades. And generally, most cases are circumscribed to urban areas. demonstrating the importance of lifestyle and environment in the pathogenesis of atopic disease.

As we said earlier, atopic dermatitis is a chronic disease, whose symptomatology varies from asthma, allergic conjunctivitis to the most commonly located erythematous rash on the face, the anticubital region and the poplitia zone. The DA is characterized by changing the organ of shock as the age of the patient increases, this phenomenon is often called “The atopic march”

Atpic march

Diagnostic features of Atopic Dermatitis

Major features present (3 of 4 present)

  1. Pruritus (itching)
  2. Typical morphology and distributions of skin lesions
  3. Chronic or chronic relapsing dermatitis
  4. Personal or family history of atopy

Minor features present (3 of 23 present)

  1. Xerosis.
  2. Ichthyosis / palmar hyperlinearity / keratosis pilaris.
  3. Immediate reactivity to the skin test.
  4. High serum IgE.
  5. Early age of onset.
  6. Tendency towards cutaneous infections / immunity mediated by altered cells.
  7. Tendency towards non-specific dermataitis of the hand or foot.
  8. Ezcema of the nipple.
  9. Cheilitis.
  10. Recurrent conjunctivitis.
  11. Infraorbital fold of Dennie Morgan.
  12. Keratoconus.
  13. Anterior subcapsular cataract.
  14. Orbital dimming.
  15. Facial pallor / erythema.
  16. Pityriasis alba.
  17. Fold of the anterior neck.
  18. Itching when you sweat.
  19. Intolerance to wool and lipid solvents.
  20. Perifollicular accentuation.
  21. Food intolerance.
  22. Couse influenced by environmental / emotional factors.
  23. White dermographism / bleached delay.


Must have:

  • An itchy skin condition (or parental report of scratching or rubbing in a child)

Plus three or more of the following:

  • History of involvement of the skin creases such as folds of elbows, behind the
    ankles, the neck and around the eyes*.
  • A personal history of asthma or hayfever (or history of atopic disease in a first-degree relative in children under 4 years of age).
  • A history of generally dry skin in the last year
    Visible flexural eczema (or eczema involving the cheeks/forehead and extensor
    limbs in children under 4 years of age).
  • Onset under 2 years of age (not used if child is under 4 years of age)

Classification of Atopic dermatitis

Infantile AD (age <2 years) typically develops after the second month of life, often initially appearing as edematous papules and papulo-vesicles on the cheeks (often sparing the central face), which may evolve AD are to form large plaques with oozing and crusting. Involvement of the scalp, neck, extensor aspects of the extremities, and trunk  can also occur, usually with sparing of the diaper area. In the first months of life, the face and the neck are affected in over 90% of patients with AD. Young infants may attempt to relieve itch through mechanisms of rubbing movements against their bedding, whereas older infants are significantly better able to directly scratch affected areas.

Atopic dermatitis on the face of an infant
Atopic dermatitis on the face of an infant

In childhood AD (age 2 to 12 years), the lesions are less exudative and tend to become lichenified. The classic sites of predilection are the ante cubital and popliteal fossae (flexural eczemal) In addition, the head (especially periorificial regions), neck, wrists, hands, ankles and feet are often affected. Xerosis typically becomes pronounced and widespread

Adult/adolescent AD (age >12 years) also features sub acute to chronic, lichenified lesions, and involvement of the flexural folds typically continues. However, the clinical picture may also change. Adults with AD frequently present with chronic hand dermatitis that has both endogenous and exogenous components, while others have primarily facial dermatitis , often with severe eyelid involvement (see below). Additional sites of predilection include the retro-auricular region, neck and chest. Patients who depending have suffered from continuous AD since childhood are more likely childhood to have extensive or even erythrodermic disease that is resistant, to treatment. Such individuals may also have severe excoriations and chronic papular skin lesions as a result of habitual in infantile scratching and rubbing.

Senile AD (age >60 years) is characterized by marked xerosis. Most
of these patients do not have the lichenified flexural lesions typical of
AD in children and younger adults.
AD has a profound adverse impact on the quality of life of affected children and adults, with intense pruritus and stigmatization often resulting in sleep disturbances, psychological distress, social isolation, disrupted family dynamics and impaired functioning at school or work.

Regional Variants of Atopic Dermatitis

Several regional variants of AD can occur in isolation or together with the classic age-related patterns of involvement described above. The face is a frequent location for site-specific manifestations. Eczema of the lips, referred to as cheilitis sicca, is common in AD patients, especially during the winter. It is characterized by dryness (‘”chapping” of the vermilion lips, sometimes with peeling and fissuring, and may be associated with angular cheilitis. Patients try to moisten their lips by Licking, which in turn may irritate the skin around the mouth, resulting in so-called lip-licker’s eczema. Another common feature of childhood AD is ear eczema, presenting as erythema, scaling and fissures under the
earlobe and in the retro auricular area, sometimes in association with bacterial super infection. Eyelid eczema can represent the only manifestation of AD, especially in adults. In contrast to eyelid eczema due to other causes, it is characterized by lichenification of the peri orbital skin.
“Head and neck dermatitis” represents a variant of AD that typically occurs after puberty and primarily involves the face, scalp and neck. When older children and teenagers present with this form of AD, it usually persists into adulthood. It is postulated that lipophilic Malassezia yeasts, members of the normal skin flora that colonize the head and neck area, represent an aggravating factor for this condition. Serum levels of M. furfur-specific IgE have been shown to correlate with the severity of head and neck dermatitis, and improvement with systemic anti fungal treatment has been observed in some patients. Sweating, heat, dryness, sun exposure and emotional stress can also aggravate this form of AD.

Atopic dermatitis causes

  • Genetic and environmental factors

Although it is still not known exactly why atopic dermatitis develops in some people, research has shown that the combination of some genetic and environmental factors play an important role.

Atopic eczema may burst and then calm down for a while, but the skin tends to become dry and itchy. It often affects the folds of the joints of the body, such as behind the knees or inside the elbows. In the skin of black people eczema often affects the front of the knees and elbows. Atopic eczema can appear in small patches or throughout the body.

Environmentals factors

Spontaneous outbreaks are often the result of triggers. Triggers are not the same for everyone, but there are a number of factors that are more common than others:

  • Soap and detergents
  • Skin infection
  • Dust mites and their droppings
  • Animal dander (skin, hair) and saliva
  • Pollens
  • Excessive heating
  • Rough clothes

Many people with atopic eczema find that there is a connection between eczema and stress, although the fact that stress causes eczema or vice versa is less clear.
Learning what the triggers can help you take control of your eczema, however, it is not always immediately obvious what has caused the onset of eczema.

The itching of atopic dermatitis

The main characteristic of atopic eczema is the itching that can sometimes make sleeping almost unbearable, leading to frustration, stress and depression. It is critical to recognize that this can affect the whole family, not just the person with eczema.
Although there is currently no known cure for atopic eczema, when it is well managed, it is possible to limit its impact on a day-to-day basis.

What to do next?

Find out about the treatment of eczema. You can find information on the range of treatment options for different types of eczema in our  Diagnosis and treatment area of ​​the website.
The main characteristic of atopic eczema is the itching that can sometimes become almost unbearable.

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